Meeting Quality Standards Phase 1: Safety 100


The nine-month programme, comprising three face-to-face meetings 90 days apart, will be delivered using the IHI (Institute for Health Improvement) breakthrough series collaborative framework. During this programme we will provide training in improvement, measurement and mobilising to support teams to work together to innovate and spread best practice rapidly. New knowledge will be archived into simple bundles and change packages which will be used to accelerate the rate of change. Learning Sessions will be held across England.


Phase 2: Safety 300


Phase two of the safety programme will be run for the system by the system. It is envisaged that three organisations (from each region) that successfully accomplished the aim within the one year time frame will be invited to act as ‘nodes’ and will replicate the programme (established in phase 1) in 10 more organisations (30 per SHA). Once again, learning and knowledge will be archived and spread rapidly by planned large scale change.


Scale Up and Spread: Safety Assured


In the ‘safety assured’ phase organisations from Phase 1 and 2 will work to sustain results and transfer learning deep within the healthcare system and to other key safety domains. Ongoing monitoring of data will be required.


Why a breakthrough series collaborative approach?


The breakthrough series collaborative (BTS) model is a proven intervention in which teams can learn from each other and from recognised experts around a focused set of objectives. The key to success is engagement, alignment and collaboration. Subject matter experts work with improvement experts who help organisations select, test and implement changes on the front line of care. Systems are re-designed from the bottom up using small tests of change. Engagement in this process is absolutely crucial to success. To date, within the field of nutrition, there has been a heavy reliance on subject experts to provide guidance and standards with little focus on the role of improvement experts to ensure widespread implementation of improvements in nutritional care. A BTS collaborative provides a framework to optimise the likelihood of success for improvement teams. It works best when there is a deficit in quality which can be identified by teams as ‘unacceptable’ and where there are pockets of excellence which can be used for learning. This approach is therefore well suited to the nutrition agenda as we can define ‘unacceptable practice’. It is unacceptable for patients not to be screened on admission; it is unacceptable for patients not to have repeat screening where required; it is unacceptable for patients not to have a nutritional care plan where one is indicated; and it is totally unacceptable for nutritional care plans not to be implemented. We also have ample areas of excellent practice, some of which are highlighted in the High Impact Actions ‘Essential Collection’ which we must use to share learning across the healthcare system.


Critical success factors include leadership support, patients at the helm, a clear aim, focus on measurement, an agreed time frame and clinical engagement. Teams commit to working together over a fixed period and attend three learning sessions. In-between learning sessions there are 'action periods' where teams test changes. Learning sessions provide instruction in the theory and practice of improvement and feedback to senior leaders, focusing the organisation’s learning. Each team reports on their methods and results, lessons learned and provide social support and encouragement for making further changes. During the intervening action periods participating teams have direct access. This is an ambitious aim and will present key challenges; we must identify the key elements of nutritional care that must be delivered to achieve the outcomes and the Toolkit provides a


sound basis on which to build this improvement work. BAPEN will continue to work closely with the organisations involved in the production of the Toolkit and the DH QIPP Safe Care Team to provide the nutritional expertise to the National Improvement Programme. Malnutrition does matter and no NHS or social care organisation can claim it is delivering safe, effective, quality care without appropriate nutritional care policies in place. These must be a priority for all and organisations that deliver good nutritional care will see improvements in clinical outcomes and patient experience whilst simultaneously achieving significant reductions in costs. Call to action: SHA’s will soon be asking organisations to opt into this programme – get involved to drive improvement for your patients in your Trust.


Figure 1 – Programme Design


Figure 2 – Breakthrough Series Model Source: www.ihi.org


BAPEN In Touch No.58 August 2010


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