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The journey -

Safe, Supportive and Therapeutic Care aimed to improve safety and care within acute inpatient mental health units; to minimise risk while maximising therapeutic benefit. A secondary but related objective was to reduce length of stay in acute inpatient units. Strands of work covered three key areas: clinical skills and interventions; policies, procedures and systems; and environmental security. Specific activities included a thorough review of clinical evidence and of policy and procedures; staff training and a ligature audit to identify and remove any environmental elements contributing to increased risk of patient suicide.  

Outcomes

The programme has achieved a wide range of improvements, including better clinical risk assessment and collaborative and patient focused care plans. Each acute inpatient environment has been assessed using an accredited ligature audit tool with high risk ligature points being addressed first and processes identified to modify medium and low risk points. The programme has created a stronger identity and culture within Acute Care, as well as greater clarity among the different professions (psychology, nursing, occupational therapy and medical) about their role and contribution to providing high quality care.  There is now greater consistency of care across acute units and the programme has also achieved its overarching aim, which was to minimise risk while maximising the therapeutic benefit of inpatient care.  

Patient setting

In-patienta Out-patient Community based
Mental health   X Chronic illness Cross-systems
 

Clinical area

Staying healthy Maternity and newborn Children and young people Acute care   X
Planned care Mental health   X Long-term conditions End of life
 

Information, tools and techniques used

Whilst some general principles of change management underpinned the programme, it did not follow a formal change model. Different change management processes included a ligature audit which used a validated tool to assess environments as well as consulting nationally in order to learn from good practice elsewhere. The review of risk policy, training and redesign of risk tools was informed by a full consultation within the trust.  

Geography

The programme was run across the six acute inpatient units and six crisis teams working in the community across the Sussex Partnership NHS Foundation Trust.  

Timescale

The programme was initiated in March 2010, and by April 2012 most of its key elements had been implemented.  

Contact details and further information

Theresa Dorey, Nurse Consultant/Professional Lead, Acute Care.

theresa.Dorey@sussexpartnership. nhs.uk

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The aims of the Partnership -

The Sussex Dementia Partnership is a clinically-led collaboration between the health and social care commissioners and providers of Sussex involved in Dementia care. It aims to transform dementia services in line with the National Dementia Strategy (NDS) in order to improve the experience of people with dementia and their carers. Dementia is a significant and increasing financial burden in Sussex. There are different commissioning and provider arrangements for dementia across Brighton & Hove, East Sussex and West Sussex. Evidence suggests that working collaboratively across organisational and geographical boundaries to implement the dementia transformation programme with a QIPP focus could enable Sussex to meet future challenges against a backdrop of financial constraint, and this has led to the formation of the Partnership. The vision of the programme is to achieve improvements in the following areas:
  • The experience of people with dementia and their carers
  • Early diagnosis of dementia and access to information and support
  • Numbers of people treated (within existing resources) in order to meet significant demographic increases over the next 10 years
  • Improved care in the general hospitals, plus a reduction in inappropriate admissions and length of stay
  • Improved care in care homes
  • Access to dementia crisis support at home services
  • Reduced inappropriate use of anti-psychotic medication
  • Reduced unwarranted variation in services across Sussex
 

Outcomes

There has been significant progress in delivering the NDS. A full Memory Assessment Service with Dementia Advisors has started in West Sussex and procurement is also underway in the other localities meaning that full coverage will be achieved by April 2013. The quality of care in general hospitals has improved notably; Older People’s Mental Health Liaison services have been extended across Sussex and the innovation of a Dementia Shared Care Ward is being spread to other hospitals. All four acute trusts have developed Dementia Strategies and are making progress in delivering improvements in education, environment and person-centred care. A Sussex wide dementia acute audit has provided the system with valuable information about the dementia profile in the hospitals and preventative approaches to admission. In care homes, a Sussex-wide service has been developed to focus on medication review and non-pharmacological approaches to challenging behaviour. This has led to quality improvements and reductions in anti-psychotic prescribing. Achievements have also been made in dementia crisis support services at home. Finally, work is in progress to improve services for people with dementia at end of life, to increase carers’ support and to provide education for the system in relation to reducing anti-psychotic prescribing.  

Patient setting

In-patient   X Out-patient   X Community based   X
Mental health   X
 

Clinical area

Staying healthy Maternity and newborn Children and young people Acute care   X
Planned care Mental health    X Long-term conditions   X End of life   X
 

Information, tools and techniques used

The National Dementia Strategy was published in February 2009 and there was widespread belief that the strategy could not be implemented effectively by individual organisations in isolation. The concept of a partnership approach was initiated by CEOs and senior clinicians within Sussex, with the Director of Social Care and Partnerships South East acting as a catalyst to bring the different parts of the system together. The principles of the Academy for Large Scale Change model were utilised, focusing on mobilising, spreading and sustaining change. Whole system modelling was undertaken to understand the impact of implementing the NDS on demand and resources.  

Geography

Across the local authorities of Brighton & Hove, West Sussex and East Sussex.  

Timescale

The Sussex Dementia Partnership was set up in January 2010, following initial meetings during 2009. A programme manager was jointly funded by NHS Sussex and a Delivery Board established. A two year independent evaluation of the Partnership will be completed in October 2012 and this will form part of a review of the future of the Partnership in the light of the transition to clinical commissioning.  

Contact details and further information

Contact Charlotte Clow, Sussex Dementia Partnership Email charlotte.clow@nhs.net [post_title] => Sussex Dementia Partnership [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => sussex-dementia-partnership [to_ping] => [pinged] => [post_modified] => 2013-01-16 14:55:40 [post_modified_gmt] => 2013-01-16 14:55:40 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3402 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 3393 [post_author] => 8 [post_date] => 2013-01-16 14:35:00 [post_date_gmt] => 2013-01-16 14:35:00 [post_content] =>

The journey -

The aim of this programme was to implement an integrated plan for the care of the frail and elderly with the aim of reducing hospital admissions.  Many older people were finding it difficult to access the right services, so part of the aim was to simplify and co-ordinate care for this group of patients. The first steps were informal conversations among interested parties.  This led to the formation of a local strategic partnership spanning health and social care specialists.  The programme looked at all areas relevant to patients aged over 65, learning disabled and other vulnerable people.  These included dementia, end-of-life care, balance classes to reduce falls and ‘living well at home.’  

Outcomes

The programme is still ongoing, but there is some evidence of fewer hospital admissions in this age group.  Another benefit has been improved relationships between strategic partners and considerable learning in areas such as aligning finances, outcome measurements, assessment processes and the politics of organisational relationships.  

Patient setting

In-patient Out-patient Community based   X
Mental health   X Chronic illness   X Cross-systems   X
 

Clinical area

Staying healthy   X Maternity and newborn Children and young people Acute care
Planned care Mental health    X Long-term conditions    X End of life   X
 

Information, tools and techniques used

The programme started with informal networking among interested parties and progressed to a more formal local strategic partnership.  Specific change management tools were not used.  

Geography

Crawley area including Crawley Borough Council; Crawley CCG; West Sussex County Council; Sussex Partnership Foundation Trust and voluntary groups.  

Timescale

The programme is still ongoing.  

Contact details and further information

Dr Amit Bhargava, GP Principal, Southgate Medical Group, Crawley: amit.bhargava@btopenworld.com [post_title] => Integrated care of the frail and elderly [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => integrated-care-of-the-frail-and-elderly [to_ping] => [pinged] => [post_modified] => 2013-01-16 14:37:39 [post_modified_gmt] => 2013-01-16 14:37:39 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3393 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 3326 [post_author] => 8 [post_date] => 2012-12-28 13:55:52 [post_date_gmt] => 2012-12-28 13:55:52 [post_content] =>

The journey -

The Wessex Deanery appraisal and revalidation service programme’s purpose was to set up and run a comprehensive medical appraisal service; appraisals were previously carried out by the PCT.  The aim was to deliver consistent and effective medical appraisals and support to doctors and, by doing this, to drive quality improvements in patient care.  Doctors were given an annual opportunity to have protected time with an expert colleague to review and reflect on their performance and practice. The deanery’s appraisal and revalidation service has aimed to create a culture change in the perception of appraisal and revalidation based on the belief that doctors will get more out of the process if they put more in and have better trained and supported appraisers.  

Outcomes

The deanery now delivers about 2,000 medical appraisals per year through about 200 medical appraisers, delivering consistent and valuable appraisals across different healthcare models. It runs appraiser training and support that was described as “exemplary” by an external quality assurance report. Also, by collating and sharing the educational needs highlighted by appraisals, the deanery has created a sharper focus for educational provision. It has also trained appraisers in mentoring skills and created a separate cohort of trained mentors for support and remediation work. The change has also brought closer alignment of medical educators with doctors and has reduced cynicism about the appraisal system and its value.  

Patient setting

In-patient   X Out-patient   X Community based   X
Mental health   X Chronic illness   X Cross-systems   X
 

Clinical area

Staying healthy  X Maternity and newborn  X Children and young people   X Acute care   X
Planned care  X Mental health   X Long-term conditions   X End of life  X
 

Information, tools and techniques used

No information available.  

Geography

The geographic area is principally the Wessex Area plus the Channel Islands with national networks across the UK.  

Timescale

Following three years as a pilot the project was mainstreamed into the Wessex Deanery GP school in April 2010.  

Contact details and further information

Dr Susi Caesar, Service Lead: susi.caesar@wessexdeanery.nhs.uk
[post_title] => Wessex Deanery Appraisal and Revalidation Service [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => wessex-deanery-appraisal-and-revalidation-service [to_ping] => [pinged] => [post_modified] => 2013-01-16 14:13:37 [post_modified_gmt] => 2013-01-16 14:13:37 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3326 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 3320 [post_author] => 8 [post_date] => 2012-12-28 13:08:17 [post_date_gmt] => 2012-12-28 13:08:17 [post_content] =>

The journey -

Enhancing Quality and Recovery is a clinically-led rapid quality improvement programme which triangulates clinically robust data to drive quality improvements in clinical interventions, patient reported outcomes and patient experience.  The programme uses accurate benchmarking of clinical practice to identify variation and then supports clinicians to innovate and improve patient outcomes. It recognises best practice and promotes a collaborative approach whereby learning is shared within and between different trusts. The EQ programme aims to streamline care and improve accountability through reliable and directly comparable information on clinical quality; and to rapidly spread and adopt evidence-based improvements to multiple settings.  

Outcomes

In the first year over 25,000 patients were tracked by the programme. Quality improvement scores show a 15 per cent improvement for heart failure and pneumonia patients, eight per cent for hip & knee and five per cent for heart attack. More granular improvements were demonstrated such as a 20 per cent increase in the number of patients with pneumonia receiving their antibiotics within six hours of arriving in the hospital. Individual trusts are able to compare their quality performance within their trust (at ward and clinician level), against other trusts across this region, with trusts in the North West and with hospitals in the United States in order to improve their quality of care.  

Patient setting

In-patient   X Out-patient   X Community based
Mental health   X Chronic illness   X Cross-systems   X
 

Clinical area

Staying healthy

Maternity and newborn   X

Children and young people   X

Acute care   X

Planned care   X

Mental health   X

Long-term conditions   X

End of life   X

 

Information, tools and techniques used

The EQ programme uses the PDSA (Plan Do Study Act) rapid quality improvement methodology, recommended by the IHI (Institute for Healthcare Improvement) and the NHS Institute for Innovation and Improvement.  The team has also used some of the principles of the MSP and Prince 2 programme management tools, adapted to suit their own purposes.  

Geography

The programme involves all acute trusts, community trusts and mental health trusts across Kent, Surrey and Sussex.  

Timescale

The EQ programme was initiated in 2009. The first data collection went live in July 2010, and the programme has continued to develop since then.  

Contact details and further information

Kay MacKay, Director, Enhancing Quality and Recovery Programme: kay.mackay1@nhs.net Further information at: http://www.enhancingqualitycollaborative.nhs.uk   [post_title] => Enhancing Quality and Recovery Programme [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => enhancing-quality-and-recovery-programme [to_ping] => [pinged] => [post_modified] => 2013-01-16 14:23:41 [post_modified_gmt] => 2013-01-16 14:23:41 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3320 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 5 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 3414 [post_author] => 8 [post_date] => 2013-01-16 15:27:53 [post_date_gmt] => 2013-01-16 15:27:53 [post_content] =>

The journey -

Safe, Supportive and Therapeutic Care aimed to improve safety and care within acute inpatient mental health units; to minimise risk while maximising therapeutic benefit. A secondary but related objective was to reduce length of stay in acute inpatient units. Strands of work covered three key areas: clinical skills and interventions; policies, procedures and systems; and environmental security. Specific activities included a thorough review of clinical evidence and of policy and procedures; staff training and a ligature audit to identify and remove any environmental elements contributing to increased risk of patient suicide.  

Outcomes

The programme has achieved a wide range of improvements, including better clinical risk assessment and collaborative and patient focused care plans. Each acute inpatient environment has been assessed using an accredited ligature audit tool with high risk ligature points being addressed first and processes identified to modify medium and low risk points. The programme has created a stronger identity and culture within Acute Care, as well as greater clarity among the different professions (psychology, nursing, occupational therapy and medical) about their role and contribution to providing high quality care.  There is now greater consistency of care across acute units and the programme has also achieved its overarching aim, which was to minimise risk while maximising the therapeutic benefit of inpatient care.  

Patient setting

In-patienta Out-patient Community based
Mental health   X Chronic illness Cross-systems
 

Clinical area

Staying healthy Maternity and newborn Children and young people Acute care   X
Planned care Mental health   X Long-term conditions End of life
 

Information, tools and techniques used

Whilst some general principles of change management underpinned the programme, it did not follow a formal change model. Different change management processes included a ligature audit which used a validated tool to assess environments as well as consulting nationally in order to learn from good practice elsewhere. The review of risk policy, training and redesign of risk tools was informed by a full consultation within the trust.  

Geography

The programme was run across the six acute inpatient units and six crisis teams working in the community across the Sussex Partnership NHS Foundation Trust.  

Timescale

The programme was initiated in March 2010, and by April 2012 most of its key elements had been implemented.  

Contact details and further information

Theresa Dorey, Nurse Consultant/Professional Lead, Acute Care.

theresa.Dorey@sussexpartnership. nhs.uk

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Category: Mental health

Safe, Supportive and Therapeutic Care

The journey – Safe, Supportive and Therapeutic Care aimed to improve safety and care within acute inpatient mental health units; to minimise risk while maximising therapeutic benefit. A secondary but related objective was to reduce length of stay in acute inpatient units. Strands of work covered three key areas: clinical skills and interventions; policies, procedures […]

Posted on Jan 16th Cat: , , , Comments: Comments are off for this post

Sussex Dementia Partnership

The aims of the Partnership – The Sussex Dementia Partnership is a clinically-led collaboration between the health and social care commissioners and providers of Sussex involved in Dementia care. It aims to transform dementia services in line with the National Dementia Strategy (NDS) in order to improve the experience of people with dementia and their […]

Posted on Jan 16th Cat: , , , , , , , , Comments: Comments are off for this post

Integrated care of the frail and elderly

The journey – The aim of this programme was to implement an integrated plan for the care of the frail and elderly with the aim of reducing hospital admissions.  Many older people were finding it difficult to access the right services, so part of the aim was to simplify and co-ordinate care for this group […]

Posted on Jan 16th Cat: , , , , , , , , Tags: Comments: Comments are off for this post

Wessex Deanery Appraisal and Revalidation Service

The journey – The Wessex Deanery appraisal and revalidation service programme’s purpose was to set up and run a comprehensive medical appraisal service; appraisals were previously carried out by the PCT.  The aim was to deliver consistent and effective medical appraisals and support to doctors and, by doing this, to drive quality improvements in patient […]

Posted on Dec 28th Cat: , , , , , , , , , , , , , , , , , Tags: Comments: Comments are off for this post

Enhancing Quality and Recovery Programme

The journey – Enhancing Quality and Recovery is a clinically-led rapid quality improvement programme which triangulates clinically robust data to drive quality improvements in clinical interventions, patient reported outcomes and patient experience.  The programme uses accurate benchmarking of clinical practice to identify variation and then supports clinicians to innovate and improve patient outcomes. It recognises […]

Posted on Dec 28th Cat: , , , , , , , , , , , , , , , Tags: , , , , Comments: Comments are off for this post