Local opportunities for improvement

Supported work in 30 out of 31 Integration Authorities

The ihub supports services and systems to understand their high impact opportunities for improvement in the following ways.

  • We provide practical tools, guidance and support to enable delivery partners to understand the extent to which the design of their current systems and processes helps or hinders the delivery of high quality care.
  • Through joint working with Our Voice (www.ourvoice.scot), we provide practical guidance so delivery partners can better understand the needs, experiences and current outcomes of those accessing care.
  • We support delivery partners to use data (qualitative and quantitative) to evaluate areas for improvement and to better understand population need.
  • We develop self-assessment tools and support their implementation, ensuring alignment with any self-assessment processes used by Healthcare Improvement Scotland’s Quality Assurance Directorate and the Care Inspectorate. We are working with the Improvement Service to further develop the Public Service Improvement Framework (PSIF) for Integrated Authorities.
  • We proactively provide information on what has worked elsewhere in delivering improvement support.
  • We provide independent facilitation to support those delivering services to develop a common understanding of their priority areas for improvement.

Examples of our work

Working with health and social care teams to build capabilities

Our Person-Centred Care programme has been working with health and care teams to build their capabilities to involve people, families and carers in the experience based co-design approach to identifying, prioritising and co-designing service improvements. This approach ensures that people who receive services, care or support are at the heart of improving them. We are currently testing this approach to: 

  • refocus antenatal education in NHS Ayrshire and Arran
  • design services to better support people in distress who currently attend the Emergency Department at Monklands Hospital in Lanarkshire, and
  • improve services in four Specialist Dementia Units in NHS Grampian, NHS Greater Glasgow and Clyde, NHS Lanarkshire and NHS Lothian.

At the forefront of a new system for mapping and visualising integrated health and social care systems

Our Living Well in Communities team is at the forefront of a new system for mapping and visualising complicated, integrated health and social care systems. The maps help Integration Authorities to gain a better understanding of their local integrated system, which helps decision-making and identifies areas for service redesign.

Comparative data is one way we support the service by identifying opportunities for improvement. As an example, NHS National Services Scotland (NSS) produced data from the Key Information Summary (KIS) system showing the variation in Anticipatory Care Plans registered on KIS. We are providing support across Scotland to increase both the uptake of Anticipatory Care Plans and the amount that are registered on KIS. Our work in this area contributed to 46,000 more Anticipatory Care Plans registered on KIS over 2016–2017.

Palliative and end of life care

We worked with Glasgow City Health and Social Care Partnership and used the method map below to support qualitative data analysis for their palliative and end of life care system. The map helped them choose where to prioritise improvement activity in the palliative care system and qualitative analysis identified a number of system-wide areas to progress. This included adopting a range of methods to support staff training in being able to quickly identify people with palliative care needs and supporting those who would benefit from having an Anticipatory Care Plan (ACP) in place.

This work is now being shared across Integration Authorities to improve the provision of palliative care and provide a more personalised service to address individual needs.

The Quality Improvement Framework for Post-Diagnostic Support for People with a Diagnosis of Dementia in Scotland

Our Focus on Dementia programme worked with people delivering and receiving dementia care and support to develop the Quality Improvement Framework for Post-Diagnostic Support for People with a Diagnosis of Dementia in Scotland. The framework sets out the outcomes which people with dementia have said are important to them when receiving post-diagnostic support and identifies the ways in which the practitioner can support them. The framework is being tested with post-diagnostic support practitioners in seven Health and Social Care Partnerships. This work will inform the national dementia dataset and local delivery plan target for post-diagnostic support, for the first time giving us a measure of quality of service provision.

Collaboration with care homes – reducing pressure ulcers

Our Reducing Pressure Ulcers in Care Homes improvement programme is working with 20 care homes in five Health and Social Care Partnerships (Argyll and Bute, Highland, Dumfries and Galloway, East Dunbartonshire and Perth and Kinross). Care home teams are focusing on education and learning, in particular the early recognition and treatment of pressure ulcers. This programme is working in close collaboration with Scottish Care and the Care Inspectorate.

71% of community pharmacy teams throughout Scotland are developing their safety culture

71% of community pharmacy teams throughout Scotland have developed their safety culture through completion of the pharmacy safety climate survey. This is part of the initiative to embed continuous quality improvement in community pharmacy settings. The pharmacy pilot sites produced a variety of innovative and functional educational resources to reduce harm from warfarin and non-steroidal anti-inflammatory drugs. This included information for professionals as well as patient information. Our Primary Care team facilitated the development of these resources.

General Practice Safety Checklist

Our Primary Care team, in partnership with NHS Education for Scotland (NES) has developed a General Practice Safety Checklist to monitor risk and improve system safety (MoRISS Tool). This comprehensive checklist was tested by GP teams in NHS Ayrshire & Arran. The checklist provides practices with a systems-based approach to ensure that safety checks are carried out routinely and promotes practice-based learning and improvement.

The checklist is in Microsoft Word format and is available to download from TURAS on the NES website: https://learn.nes.nhs.scot/1033/patient-safety-zone/patient-safety-tools-and-techniques/moriss-checklist/monitoring-risk-and-improving-system-safety-moriss-checklist