Quality Improvement Fellowships
Quality Improvement Fellowships equip senior NHS clinicians with the tools and techniques of quality improvement.
They aim to develop senior leaders who have enthusiasm, experience and skills to promote quality improvement nationally and build organisational capability to deliver dramatically better care at the local level.
Fellows spend a year in the USA working with the Institute for Healthcare Improvement (IHI). On their return, fellows can use the skills and techniques they have learnt to make a positive influence in their own organisations.
Jason Leitch
Jason Leitch was a Quality Improvement Fellow in the USA in 2005. He is now helping lead the Scottish Patient Safety Alliance in overseeing Scotland’s first national patient safety programme.
Studying how healthcare systems work in other countries is one of the best ways to improve the service in the UK. Recognising how innovative ways of doing things can be translated to another national context is key. A prime example of this is Jason Leitch.
Introduction to healthcare improvement
Jason began his fellowship at the Harvard School of Public Health, taking a course on quality improvement run by the Institute for Healthcare Improvement (IHI). ‘Even at that early stage, you find yourself thinking ‘there’s something different about this’ Jason says. ‘It’s about trying to bridge the gap between academic research and implementation – all the things that often frustrate clinical academics like me.’
After the course at Harvard, Jason joined a practical IHI project in Colorado, called the Oral Health Collaborative. He was chosen for this because of his clinical background in dentistry. ‘I understood the content around dentistry but I didn’t know the improvement methods. It allowed me to learn the methodology while doing a subject that I was comfortable with,’ he comments.
The project aimed to increase access to dentistry for young children and pregnant women. It did this by using community health centres to treat uninsured patients. ‘There are 100 million dentally uninsured people in the USA, compared with 50 million medically uninsured,’ Jason explains. ‘So dental provision is very poor in many deprived areas. The community health centre system is often people’s only solution.’
Jason’s role was to help coach teams to identify where services could be improved and help them implement changes. ‘The key is to empower the teams to make the changes themselves,’ he comments.
Back in the UK: change of career path
Jason's oral surgery role wasn't making use of his new knowledge
Jason’s experience with IHI led to a major change in his career path when he returned to the UK. ‘Initially, I went back to my clinical academic oral surgery consultant job at the Dental School in Glasgow. But I didn’t feel I was using my new knowledge as much as I would like to,’ he explains. ‘So I started talking to people like the Chief Medical Officer and others in the Scottish Government who were interested in forming some kind of relationship with IHI around patient safety.’
The conversations proved fruitful and, in March 2007, the Scottish Patient Safety Alliance was launched. Scotland’s Chief Medical Officer Dr Harry Burns launched the campaign at Ninewells Hospital, NHS Tayside. It was based on the successes seen by NHS Tayside through its involvement in The Health Foundation’s Safer Patients Initiative (SPI). Jason was asked to come on board as National Clinical Lead for Safety and Improvement.
‘It uses IHI’s methodology, based on the Safer Patients Initiative that The Health Foundation had funded. We’re expanding what Tayside has done to the rest of the country,’ Jason comments.
Aims of the Scottish Patient Safety Programme
The Scottish Patient Safety programme has now been up and running since June 2008. It aims to reduce mortality rates for inpatients by 15 per cent by January 2011. It plans to reduce adverse events in acute facilities by 30 per cent by the same date. This programme is a major country-wide collaboration being coordinated by NHS Quality Improvement Scotland in collaboration with IHI.
‘We have a series of aims underlying each of our interventions, like 300 days between central line infections,’ Jason says. ‘A measurement system has also been put in place, based on the SPI model. We have programme managers in each of the territorial boards in Scotland entering data into a private website once a month.’
Even collecting patient safety measures at national level has been a major step forward. ‘You’d be surprised how many hospitals didn’t keep track of how many people had heart attacks on their wards in a month,’ Jason says.
Once the measures have been reported, the data is assessed by the team to check progress. Regular site visits are arranged to deliver coaching and learning sessions.
‘We give examples of how they can change, maybe by introducing the central line infection bundle, something to reduce surgical site infections or early rescue teams,’ Jason says. ‘We use the plan-do-study-act cycle to empower the frontline teams to actually implement these changes.’
The support structure continues
Jason (4th from left) with Quality Improvement Fellows at IHI
Jason is now employed full time by the Scottish Government but still benefits from the expertise and insight of his former colleagues on the fellowship. ‘There’s now a definite community of Quality Improvement Fellows, particularly those who have been to IHI,’ Jason says. ‘We meet quarterly with a leadership consultant and work on the issues we’re currently facing.’
‘The Health Foundation’s help has been completely invaluable,’ he continues. ‘They have also used some of us for teaching, so we’ve gone round the country talking about quality improvement. I think the support has been great and is improving.'
13 August 2008
