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SCRUTINY: AN INTEGRAL PART OF IMPROVEMENT

SCRUTINY: AN INTEGRAL PART OF IMPROVEMENT. CONTEXT . the Scottish context Quality Strategy external confidence and assurance at a time of financial constraint and rising expectations shifting balance in power between health professionals and patients

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SCRUTINY: AN INTEGRAL PART OF IMPROVEMENT

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  1. SCRUTINY: AN INTEGRAL PART OF IMPROVEMENT

  2. CONTEXT • the Scottish context • Quality Strategy • external confidence and assurance at a time of financial constraint and rising expectations • shifting balance in power between health professionals and patients • integration of care - regulation & scrutiny with fewer boundaries

  3. MID STAFFORDSHIRE

  4. INTEGRATED CYCLE OF IMPROVEMENT

  5. TIMELINE 6th June 2011 Cabinet Secretary announcement directing HIS to undertake inspections of care of older people in acute care 29th November 2011 Scottish Parliament Health and Sport Committee Report published on Inquiry into the Regulation of Care for Older People 1st December 2011 Letter to Chair HIS setting out the policy context from Director General

  6. TIMELINE October – January 2012 6 test inspections completed 3rd February 2012 Letter to Chief Executive, HIS asking for the formal programme of inspections to commence as swiftly as possible

  7. 6 INSPECTIONS UNDERTAKEN • Western Infirmary 21st February • Hairmyres Hospital 5th March • Royal Alexandra Hospital 14th March • Western General Hospital 11th April • Glasgow Royal Infirmary 2nd May • Wishaw General Hospital 28th May Reports published with improvement action plans

  8. INTEGRATED CYCLE OF IMPROVEMENT • Improving Older People’s Care in Acute Hospital programme • Key themes adapted to other work • Local self assessment • Local inspection report • Older People in Acute Care Clinical Standards • National Care Standards • Review of literature: CAAP process (April 2012) • Relevant reports eg Audit Scotland • Inspection of Older People’s Services in acute care • Learning from other reports

  9. AREAS OF STRENGTH • Caring behaviours of staff, taking account of privacy, dignity and respect AREAS OF IMPROVEMENT • Staff don’t always act to safeguard the best interests of patients with dementia, their families and carers(legal and ethical implications) • Food, fluid and nutrition • Pressure ulcer care

  10. Building the Improvement Programme

  11. USING THE EVIDENCE • Patient and User feedback • Observation in the ward • Research and evidence • Reports and Reviews • Standards of practice and care • Common Sense

  12. WHAT NEXT ? • We know the size of the problem • We know where we want to get to • What are the few things which we know will make a difference ? • How do we bring them together ?

  13. Building the Improvement Programme Research and Development. Driven by need Prototype Ideas shaped by small scale tests of change Spread Good practice supported by Quality Improvement Sustainability Part of normal working ensured by Scrutiny

  14. Improving care for older people in acute hospital Integration of Scrutiny and Improvement 3 Improvement Plan 2 Inspection Themes Continence Falls Nutritional care Dementia Tissue Viability 1 Local NHS board test sites

  15. Improving care for older people in acute hospital Integration of Evidence and Improvement MUST screen in 24 hours • Nutritional care Assistance at meal times Hydration

  16. Improving care for older people in acute hospital Integration of Evidence and Improvement Environmental issues • Falls Falls Prevention Assessment

  17. THANK YOU Any Questions ?

  18. QUESTIONS • What are the challenges/opportunities  in integrating inspection and improvement ? • What opportunities do you see in integrating inspection and improvement of older people? • How do you ensure the patient/carer is central to all scrutiny and improvement work?

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