Darzi Project Update Nazia Ahmad

Two main aims: Quality Improvement & Model wards

Quality Improvement

Current QI Projects

  1. Antibiotics on BBA & BBB (aim: to improve adherence to 48 hr check)
  2. MRU/ERU prescribing errors (aim: Reduce prescribing error on MRU/ERU)
  3. Learning loop (aim: n=1 QI as suggested)
  4. Death Certification (aim: standardize death certification form)
  5. Outpatients clinics KGH (aim: reduce waste in OP clinic)
  6. E-referral (aim: reduce lost forms by change all TCI forms electronic)
  7. Potential from cardiac arrest (potentially around learning post cardiac arrest using a method such as AAR)
  8. Potential Pharmacy OP project (aim to be formulated)
  9. Project about FY1 doctors** (this hasn't been established as a QI project yet)

The antibiotic on BBA /BBB project is completed. The rest of the projects are at various stages. Most of them are registered on LIFE. Sharing learning: on link + QI conference

Capability building

  1. QI steering group established
  2. Monthly teaching Foundation for QI
  3. QI conference in July HENCEL

A QI steering committee was setup with the following aims. The steering group to act on principles of communities of practice (with the practice being QI) - see attached leaflet on CoP

  1. Improve QI capability within the trust
  2. Support for delivering the outcomes set by HEENCEL QI forum
  3. Act as champions for QI and support projects within the trust with your expertise
  4. Provide a forum to discuss current QI projects and get insight from other QI leaders

Future view:

  • Establish QI page on intranet
  • Liaise with BEST re online training
  • Finalise with Caroline Curtain the embedding of QI in medical teaching from next intake
  • Liaise with education lead for nurses and AHPs re: QI teaching

There is also collaborations with Care City, NELFT & BHR CEPN. Joint across boundary working e.g. falls collaborative etc.

Model Wards

What does a model ward look like?

Actions completed:

  • reviewed current models of practice ( UCLH, Salford, USA)
  • Identify best practice from each model
  • develop a model for the 'Model ward': 4 pillars
  • develop what each pillar should measure
  • Identify Pilot wards

Current state:

what will success look like (by Sept):

  • Three wards assessed
  • Improvement program on these ward supported by the KPO
  • Embedded teaching for QI (medical staff)
  • self-sustaining QI steering group
  • Ongoing potential MDT action learning sets to build on staff experience

Challenges & assets

  1. Competing priorities (Trust level - CQC, CQUIN & for me - University, HENCEL and balancing other opportunities on offer)
  2. Staff engagement and response times: Engaging stakeholders for the development of accreditation tool has taken a lot longer than anticipated. Some of this is down to me not knowing who the right people to get in touch with are, some of this is also around colleagues cancelling meeting last minute, non-response etc... Similarly, for QI projects, it takes the person who has the idea a lot longer to engage with team that is required to complete the project.
  3. Capability & capacity: I feel that some staff want to take a JFDI approach to solving problems. QI takes time and effort when done well... this has impacted on the number of folks who have decided to do proceed with an idea as an audit rather than a QI project.
  4. Culture: This is also to do lack of QI maturity within the given system. There is some incidence of staff having a fixed mindset. There is a fear of being seen to fail. Staff have struggled with the idea of trying to do something that might not yield predictable positive results.
  5. Change fatigue
  1. QI: Any project that are supported by leaders, who are known, respected and present at meetings, has meant that things get done.
  2. Will to improve: Throughout all the Action Learning Sets for Model wards and QI coaching for ongoing projects, the will to do something better is present abundantly in staff.
  3. Pharmacy staff: real enthusiasm for QI. They should be QI champions in areas of practice
  4. Out of Special measures: potential now to maximize on people attention to improve rather than work continuously in a quality assurance framework
  5. Potential Breakout collaboratives across the patch

Hope this has made sense. Happy to answer or expand on anything I've mentioned here.

Created By
Nazia Ahmad

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