Our global networks: A Scottish perspective of change priorities

20 Jun 2013

by Gerry Marr, CEO Tyneside NHS Trust

Gerry MarrThe recession in Europe has been very deep but we believe that over time the economic challenges will resolve.  We now need to respond to the demographic challenge of an aging population and the burden of disease that we will experience over the next 20-30 years.  We need sustainable solutions to these challenges while at the same time, meeting the growing expectations of a population to be healthy, and to access safe and effective care when needed. So how are we tackling these challenges in Scotland?

Our healthcare system believes we have a choice – to survive or thrive. Too often, when the financial pressures seem a great burden, we take short-term measures to simply balance the books on a year to year basis.  Often, this is construed by staff as eroding the quality of care that they seek to deliver and becomes a demotivating factor. However, I believe, we can demonstrate, that there is an opportunity to manage costs whilst driving up quality in our systems. In Scotland, we have tackled the issue of waste, harm and variation in a sustained manner.  The level of unwarranted variation in our systems of care is quite profound.  Healthcare systems need to have a systematic way of uncovering unwarranted variation, engaging front line clinicians and tackling it in a way that improves the care that we deliver.

Regrettably we know across the world that we unintentionally harm our patients.  The Scottish Patient Safety Programme was launched in 2008 based on the “100,000 lives” campaign in USA.  By supporting front line staff to build reliable processes of care, we have seen remarkable improvements in reducing unwarranted harm.  We have reduced adjusted mortality over the last 3 years by 13.8%, ventilator acquired pneumonia in our Intensive Care Unit by over 80% and have all but eradicated central line infections in our acute settings.  This approach to patient safety is now replicated across Mental Health, Children’s Services and Maternity care and now moving into Primary Care. If we work together to tackle waste, harm and variation, then we can improve the quality of care, reduce our costs and improve the care experience – delivering our Triple Aim.

The international evidence on the characteristics of high performing, high quality healthcare systems, describes organisations that demonstrate a strong culture of improvement, learning and measurement. All of them invest significantly in ensuring front line staff have the skills and tools to implement improvement.  Creating the conditions for those who touch the patient to lead improvements in care is crucial. Martin Marshall writing in the Lancet in February in what I consider to be a pivotal article on improvement science and healthcare says:

“By integrating science with clinical priorities, by bringing together those who care for patients and those who study that work, and by committing all those involved to the same values, the science of improvement has great potential to benefit patients”

The growing movement in quality improvement is profound.  The training curriculums for medicine and nursing in the UK are changing to include improvement science and patient safety. Building capacity and capability with our future workforce as well as our existing workforce will build strong multiprofessional teams orientated to safe and effective care.

In conclusion, to transform health systems, we need to thrive on a programme that relentlessly seeks to reduce waste, unwarranted variation and drive out intended harm.  But to do so, we have to build health systems that create capacity, capability, the time and the space for our frontline staff to drive improvements.  The only way that we can do that is through a sustained programme of clinical engagement and partnership, not only with our staff but with our communities as we seek to continue to deliver the highest quality of care possible to those who need it most.

Marshall,M, Pronovost, P, Dixon-Woods, M. Promotion of improvement as a science. Lancet 2013; 381: 419–21