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
Before we start
Declaration of Interests
• I am employed by The BMJ
• My salary is funded by The Health
Foundation
What do we mean by engagement?
https://www.merriam-webster.com/dictionary/engagement
A journey of engagement
Why does engagement matter?
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
And...
Patient experience and satisfaction
“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
So, why aren’t clinicians engaged?
Dr Joanna Bircher
What helps or hinders engagement?
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
Science Museum, London
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
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
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
So, what should we do?
Heifetz & Linsky, Leadership on the Line, Harvard Business School Press, 2002, p108 via Jack Silversin & Gary Kaplan, Virginia Mason, 2018
1. Productive distress
@davegray www.xplaner.com
2. Head, heart & hands
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.
Heart: create a QI culture
https://blog.hrn.io/demystifying-people-analytics-part-3-the-power-of-storytelling/
Hands: build capability
qi.elft.nhs.uk
How the story ends
https://beckymalby.wordpress.com/
BMJ Publishing Group Limited 2013. All rights reserved.