21st August 2015

Developing an NHS Lothian Clinical Quality Management System.

Over the last few months, many of you have attended meetings of the Clinical Change Forum (formerly known as the Clinical Change Cabinet) where we have discussed the increasing challenge of trying to deliver quality healthcare at an affordable cost in the face of the rapidly changing demography of the patients using our services. Funding for the NHS is under increasing pressure and it is clear that achieving year-on-year efficiency savings by focusing on rationalising inputs to the system (workforce, assets) is likely to prove increasingly difficult, as well as disproportionately affecting staff morale and quality of care. Many of you are already working on redesigning and improving services to address these issues but this improvement work has not been ‘core’ activity for us to date.

Over the course of the last week, hundreds of staff attended workshops and sessions with Dr Brent James, the Chief Clinical Quality Officer with Intermountain Healthcare who shared with us aspects of their total Quality Management Approach. He described how they use financial and activity data to map clinical pathways and develop a clear understanding of clinical processes and variation within their services. They then routinely use this data to underpin improvement and ensure sustainability of improvement through their management systems.

In all highly reliable healthcare organisations, it is clear that senior leadership commitment to the importance of the work, the introduction of a consistent improvement methodology and creating improvement capability within the workforce, are key to the successful delivery of improvement strategies.

Building on this, our strategic plan (Our Health, Our Care, Our Future) and our core values, I now propose to develop and implement a total Clinical Quality Approach for NHS Lothian, which aims to deliver ‘high quality, safe and person-centred care at the most affordable cost’. This acknowledges that every £1 million of waste, unnecessary or inappropriate cost in one area of our system, denies us the opportunity to invest that £1 million in another area of our system.

This total Clinical Quality Approach will embrace clinical pathways and processes across primary, secondary and social care services, physical and mental health services and engage senior clinicians and managers in our major acute hospitals and in our four new Integration Joint Boards.

Key elements of this will include:

  • The development of a Clinical Quality Academy which will deliver training and build capacity and capability for quality improvement within the service
  • The development of a Clinical Quality Programme which will support service based clinical teams to identify key priorities for improvement and support, guide teams with pathway mapping, testing and implementing change and tracking and maintaining improvements within the service
  • Pathway work within clinical services will be led by Clinical Quality Management Leads supported by appropriate expertise from the Quality Program support team and reporting within the new corporate management structure.

The infrastructure to support this will clearly evolve over the coming months and years but in order to make a start and maintain the momentum built up over recent months, I have asked Dr Simon Edgar, with his educational background as Director of Medical Education to lead the establishment of the Clinical Quality Academy and Dr Nikki Maran, with her background as Associate Medical Director in patient safety and quality to lead the development of the Clinical Quality Programme.

The Clinical Quality Executive Board, which I will chair, will identify the first clinical pathways to be worked through the Clinical Quality Programme and Clinical Quality Academy as we develop. Over the coming months, multi-professional clinical teams within every service area will have the opportunity to identify key pathways or processes that would benefit from redesign or improvement and support through the Clinical Quality Programme. The criteria for pathway selection are still to be finalised but will rely heavily on use of clinical process and outcomes data. Draft criteria are set out at the foot of this letter for information and comment. We recognise that significant investment will also be required in developing our data and financial analytic capacity to support all of this work.

Prioritisation of pathways to be incorporated into the programme will be decided by the Clinical Quality Executive Board. The number will initially be limited by our capacity. However, as our quality improvement infrastructure, capacity and capability grows, our ultimate plan is to have 100% participation for all staff across NHS Lothian and our four Integration Joint Boards in quality improvement in clinical practice. A business case is now being developed to allow us to leverage additional financial support from the NHS Board, the Scottish Government and the Edinburgh and Lothians Health Foundation to enable us to accelerate the pace and scale of our infrastructure development to meet our ambitions.

We have all acknowledged the need for change and I hope you share in my enthusiasm for this approach. We will have the opportunity to discuss this further at the next Clinical Change Forum on the afternoon of the 30th September, and I would value your feedback as well as using this opportunity to answer any questions. A programme for the meeting will be made available as soon as possible and you can register to attend the event by emailing: ourhealth.ourfuture@nhslothian.scot.nhs.uk

I look forward to driving this ambitious and exciting programme of work forward with you over the months and years to come.

Chief Executive