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Quality & Safety Improvement:

Why is it important to engage clinicians and how can we do so?

Dr Cat Chatfield

Quality Improvement Editor, The BMJ 15th November 2018

@drcatchatfield

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Before we start

Declaration of Interests

• I am employed by The BMJ

• My salary is funded by The Health

Foundation

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What do we mean by engagement?

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https://www.merriam-webster.com/dictionary/engagement

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A journey of engagement

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Why does engagement matter?

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Staff turnover & absence

The difference that engagement makes

West & Dawson, Employee Engagement and NHS Performance, The King’s Fund 2012 Employee engagement, sickness absence and agency spend in NHS trusts, NHS England, 2017

Spend on agency staff Infection rates

Patient mortality

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And...

Patient experience and satisfaction

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“We have learnt from our inspections and ongoing relationships that high-

quality organisations delivering outstanding care have embedded systematic improvement cultures”

Quality improvement in hospital trusts: Sharing learning from trusts on a journey of QI, Care Quality Commission, 2018

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So, why aren’t clinicians engaged?

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Dr Joanna Bircher

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What helps or hinders engagement?

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Enabling Forces Restraining Forces

Engaging Clinici ans in QI

Leadership Support Protected time

Recognition Patients

Data Capability

Network

Perception of QI Competing priorities Not my responsibility

Care good enough Lack of MDT working Skills/knowledge deficit

Professional autonomy

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Science Museum, London

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Heifetz & Linsky, Leadership on the Line, Harvard Business School Press, 2002 Silversin & Kaplan, Virginia Mason Institute, International Forum for Quality and Safety in Healthcare, 2018

• Problem well defined

• Solution is known and can be found

• Implementation is clear

Technical vs adaptive challenges

• Challenge is complex

• Solution requires

changing deeply held values & habits

• Requires learning &

new way of thinking

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Fulop NJ, Ramsay AI, Perry C, et al. Explaining outcomes in major system change: a qualitative study of implementing centralised acute stroke services in two large metropolitan regions in England. Implement Sci. 2016;11(1):80. Published 2016 Jun 3. doi:10.1186/s13012-016-0445-z

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Morris Stephen, Hunter Rachael M, Ramsay Angus I G, Boaden Ruth, McKevitt Christopher, Perry Catherine et al. Impact of centralising acute stroke services in English metropolitan areas on mortality and length of hospital stay: difference-in-differences analysis BMJ 2014; 349 :g4757

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So, what should we do?

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Heifetz & Linsky, Leadership on the Line, Harvard Business School Press, 2002, p108 via Jack Silversin & Gary Kaplan, Virginia Mason, 2018

1. Productive distress

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@davegray www.xplaner.com

2. Head, heart & hands

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Head: give them the data

Spencer E, Walshe K, National quality improvement policies and strategies in European healthcare systems BMJ Quality & Safety 2009;18:i22-i27.

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Heart: create a QI culture

https://blog.hrn.io/demystifying-people-analytics-part-3-the-power-of-storytelling/

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Hands: build capability

qi.elft.nhs.uk

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How the story ends

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https://beckymalby.wordpress.com/

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BMJ Publishing Group Limited 2013. All rights reserved.

• Den Norske Legeforening

• Dominique Allwood

Web: www.bmj.com/quality-improvement Email: cchatfield@bmj.com

Twitter: @drcatchatfield

Thank You

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