How to use LifeQI for Triple Aim Projects

Three Part Data Review

Triple Aim: How to undertake the 3 part data review. Please click on the image to open document.

Identifying a Population

Use this resource to help you think about how to Identify a Population. Click on the image to download.

Things to consider when choosing a population

You might have a number of potential population segments in consideration. Below are some key things to consider when picking where to start:

• Is there an opportunity to improve all 3 aspects of the triple aim – population health outcomes, quality of care provided, and value for money?
• Is there a segment of the population that is failing to thrive, where there might be some inequity apparent?
• Is there an urgency to do something differently / redesign the system for this population segment?
• Do we have a really good idea who is in of this population? (Can we count them?)
• Do we have access to data that we can track regularly on outcomes, quality of care and value?

Annual IHI visit to ELFT

On Tuesday 16th October we are delighted to welcome our partners from IHI to the Trust for a three day visit.

This is the fifth time the IHI team have joined us for an annual visit. This year we’re pleased to welcome Derek Feeley, Pedro Delgado, Bob Lloyd and Trissa Torres and look forward to the support and guidance they will give us with QI and our mission to improve quality of life for all people we serve.

Hundreds of staff, service users and carers will be meeting with IHI colleagues in a variety of sessions over the three days. Please see the table below for an overview of what’s happening and watch this space to find out how the visit went.

Find out more about the 2017 IHI visit to ELFT here >>

Learning from Bellin Health, an integrated healthcare provider in Wisconsin (US)

Chris Woleske, Chief Operating Officer at Bellin Health (and due to take up the CEO role from October), spent three days at ELFT last week sharing her experience and Bellin’s model for delivering high performance healthcare.

Bellin Health is widely renowned as one of the highest performing integrated care systems in the US. It  operates in Green Bay, Wisconsin, (home to the Green Bay Packers American football team!) and comprises a range of hospitals, healthcare providers and community-based partners. Bellin Health is a strategic partner to the IHI, just as ELFT is, and so we have managed to learn a lot from Bellin over the past few years. Our new ELFT strategy has incorporated lots of learning from Bellin’s strategy.

During a three-day visit to East London NHS Foundation Trust, Chris Woleske learnt about ELFT’s progress with its new strategy, and spent time with several groups working to deliver the strategy. She also delivered a masterclass, sharing Bellin’s high performance healthcare model which comprises:

1 – the strategic dimension

2 – the system of production

3 – the system of measurement

4 – the system of improvement

5 – the system of communications

6 – high performance culture

She left this message for all ELFT staff after the High Performance Healthcare Model masterclass on 16 August:

The presentation can be found here.

Over the past twenty years, Bellin Health has developed a ‘high performance health care model’ which integrates planning and improvement into the way the organisation is run. Bellin Health has also undertaken a large amount of triple aim work to improve population health, quality of care and cost of care, with much of this being done in partnership with the local community. Bellin’s work has been instrumental in helping us at ELFT develop our new mission and strategy.

High Performance Healthcare Model – achieving Triple Aim Results in Populations

Bellin Health is widely renowned as one of the highest performing integrated care systems in the US and comprises a range of hospitals, healthcare providers and community-based partners. During a three-day visit to East London NHS Foundation Trust, Chris Woleske learnt about ELFT’s progress with its new strategy, and spent time with several groups working to deliver the strategy. Here’s her Masterclass presentation slides.

ELFT and The Institute for Healthcare Improvement working together on the Triple Aim

In June 2018, Dr Trissa Torres and Catherine Craig from the Institute of Healthcare Improvement (IHI) visited the Trust to help us further develop our Triple Aim work.

Trissa and Catherine have extensive experience in supporting healthcare organisations and systems to work towards the triple aim of improving population health outcomes, experience of care and value for money.

Find out more about the ELFT Triple Aim work developing in East London and Bedfordshire in this short video:

ELFT’s approach to improving the quality of life for those we serve

Marco Aurelio, Improvement Advisor

In this blog, Improvement Advisor Marco Aurelio explains the Population Health approach and describes which projects are currently under way at ELFT.

ELFT’s new vision is to improve the population of all we serve. This places us with a much broader remit within our local community and we need to think about how we deliberately work with our partners. This is reflected in our new mission:

By 2022, we will build on our success and lead on the delivery of integrated care. ELFT will do this by working purposefully in collaboration with communities and our partners, always striving towards continuous improvement in everything we do.

So how are we going to be supporting this? One way in which we are going to be doing this is by adopting a population health approach to working with our partners. Population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”[i]. This is quite a broad term and so population can be thought of geographically, demographically or via a specific condition among other defining factors[ii]. Populations that people have previously identified as areas for improvement work are:

• Employees at Bellin Health Wisconsin USA
• Adults over the age of 65 with multiple complex conditions at NHS Kernow, Cornwall
• Black males with hypertension in Shelby USA.

What does this look like at ELFT?

Going forward we have a responsibility to work with our partners more closely and so over the next twelve months we will be providing improvement support to partners in London and Bedford. In London we are working as part of the Tower Hamlets Together system, which is a group of health and social care organisations across the borough including Barts, ELFT, Care Commissioning Group (CCG), Local authority and voluntary sectors. Whilst across Bedford we are working with a range of partners within the Sustainability and Transformation Partnership (STP).

One way we will be working with our partners to think differently about tackling problems in their population is through using the Triple Aim framework. Developed by the IHI, the Triple Aim understands that healthcare systems have a responsibility to simultaneously improve health outcomes, experience of care and improve value (reduce costs) for the specific populations they are targeting.

When beginning to think about undertaking work in pursuit of the Triple Aim, the first step is to consider which population we are going to be working with. To help with this, teams undertake a three-part data review looking at utilising data, feedback from clinicians and service users to understand the needs and assets of the population. Having narrowed a population, teams then work to develop and aim, driver diagram, theory of change, measurement systems and begin with testing changes using PDSA cycles.

 Tower Hamlets Together

Within Tower Hamlets, work is aligned to three different “life course” work streams: Born Well, Growing Well (Children and Young People), Living Well (Healthy Adults) and Promoting independence (complex care). The aim is for each of these areas to identify a distinct population to work with and run one QI project. Since January we’ve help facilitate a number of development sessions introducing QI and the framework for triple aim work. Over the next few months we will be bringing the teams working on this together during 6 weekly learning sets to share learning and accelerate the work.

 Bedfordshire

Our partners in Bedfordshire are also thinking about what populations they might like to use the triple aim framework to improve aspects of health. In May a range of stakeholders from commissioning, acute and primary care were brought together in a morning session alongside the Catherine Craig from the IHI. This provided an opportunity to explore working with local populations on some triple aim work.  We are currently working with partners to identify a population to begin working with.

[i] Kindig, D., & Stoddart, G. (2003). What Is Population Health? American Journal of Public Health, 93(3), 380–383.

[ii] http://www.ihi.org/communities/blogs/population-health-population-management-terminology-in-us-health-care

The Triple Aim Journey: Improving Population Health and Patients’ Experience of Care, While Reducing Costs

Case studies of three organisations participating in the Institute for Healthcare Improvement’s Triple Aim initiative shed light on how they are partnering with providers and organising care to improve the health of a population and patients’ experience of care while lowering—or at least reducing the rate of increase in—the per capita cost of care. The organizations—CareOregon, Genesys Health System and QuadMed —were selected to illustrate diverse approaches. Lessons from these organizations can guide others who wish to undertake or promote transformation in health care delivery.

Click on the image to access the resource.

Signature Health: A Triple Aim Improvement Story

As part of its participation in the IHI Triple Aim Community from 2012 to 2014, Signature Healthcare in Brockton, Massachusetts, initiated its Complex Care Clinic, a 12-month pilot program focused on one of its most challenging patient populations — high-risk Managed Medicare elderly patients with complex needs. For this population, Signature decreased acute admissions by 43 percent, reduced emergency department utilization by 30 percent, and improved patient care by restructuring its primary care practice and connecting these patients with resources readily available throughout the surrounding community. This improvement story is based on an interview with Lorraine (Lori) Pigeon, NP, former Director of Clinical Geriatrics and High-Risk Populations at Signature Healthcare. The Complex Care Clinic at Signature Healthcare continues under the leadership of Marc Greenwald, MD, and Cristine Waldron, NP.

Click on the image to access this resource.

Health Improvement Partnership of Santa Cruz County: A Triple Aim Improvement Story

The Health Improvement Partnership (HIP) of Santa Cruz County, California, serves as the backbone organization for a coalition of stakeholders: cultivating shared goals, collecting data from stakeholder groups, establishing venues for collaboration, communicating clearly and transparently, and incubating new care models. In this paper, Catherine Craig describes how HIP was formed and functions as the backbone organization for the county’s Triple Aim efforts, and how its governance structure defines and supports a portfolio of projects to improve the health of the community’s population.

Click on the image to access this resource.

Healthy Shelby Initiative: A Triple Aim Improvement Story

The Healthy Shelby Initiative (Healthy Shelby) is one of five initiatives of Common Table Health Alliance, a regional health improvement collaborative in Shelby County, Tennessee. It provides leadership and backbone support for a broad stakeholder coalition: cultivating shared goals, collecting data from stakeholder groups, carrying out communication campaigns to increase public awareness of health, and cultivating the adoption of innovative care methods. In this paper, Catherine Craig describes this Triple Aim improvement story describes how Healthy Shelby began its work to improve population health, how it serves as a backbone organization for the community’s Triple Aim efforts, and how its governance structure supports the improvement of health outcomes in Shelby County.

Click on the image to read this document.

Quality Conference 2018 highlights

Over 400 people, including ELFT staff, service users, carers, governors as well as external guests, attended the annual Quality conference on 24th April 2018.  Below you can read about the highlights of the day.

The ELFT Quality Conference 2018 was composed of powerful presentations, the revelation of the trust’s new mission statement and inspiring conversations. In her closing speech, ELFT  CEO Dr Navina Evans emphasised that the 2018 Conference was special because it coincided with the launch of the trust’s new strategy, which embodies the trust’s priorities around the Triple Aim.

“We took our time, we really wanted to think about how this trust does that is relevant for the communities that we serve. Our new ambition is bold, it is challenging and our mission”, Dr Evans said. “We realised that we cannot continue to do what we do and to improve in isolation”, she added, whilst also making the point that without patient input into quality improvement it is a pointless discussion.

Earlier that week, the trust released its new strategy, which is the culmination of over 100 focus groups and discussion with more than 800 staff, governors and service users. “We want this strategy to be meaningful to every single person who works in this organisation, every single person who comes into contact with us and who uses our organisation and for every single person to hold us to account on what we promised to deliver.”

You can watch Dr Navina Evans’ full speech here.

At the start of the Conference delegates were greeted by the energetic ELFT Beats! drummers, supported by the expertise of the Pandemonium Drummers. A video celebrating highlights of the past year opened the day’s agenda, followed by remarks from the trust’s Chief Quality Officer Dr Amar Shah and Chair Marie Gabriel.

The first keynote address was delivered by Dr Jennifer Dixon, CEO of The Health Foundation. Her presentation focused on the role of improvement approaches to make progress on population health.

You can watch her presentation and view her slides here.

Breakout sessions

Delegates were also able to join two breakout sessions in the morning. In the World Cafe rooms, each attendee had the change to hear directly from three of a total of 18 project teams about their QI journey and what they have learned so far. Themes revolved around improving access, service user involvement, reshaping community services, enjoying work and learning from failure.

Short video presentations from all projects were also on display during the conference. You can access the content here.

The session S+P+C=O, which is short for Structure + Process + Culture = Outcomes, was led by James Innes, Associate Director of Quality Improvement, Duncan Gilbert, Head of Quality Assurance and colleagues from our City & Hackney Adult Mental Health Service. They presented work and achievements made in City & Hackney around reducing harm from violence. You can access the slides here.

In the afternoon, external delegates took part in four workshops. Materials used in those sessions can be accessed here: Leadership for Improvement; Tips and Tricks for getting started with QI; Research and Improvement; and Service User and Carer Involvement.

Arts at ELFT

Also as part of the Conference we unveiled our ‘Working together on the triple aim‘  illustration developed in partnership with Sonia Nosheen, who is also known as Sonia Sparkles. The illustration is a result of a collaborative art project, facilitated by ELFT Arts. The poster reflects how service users, carers and staff see trust’s Triple Aim journey.

You can learn more about the process that led to the creation of the poster below.

What to see more?

Below you can see a photo gallery and a video in which delegates comment on their experience.

Working Together on the Triple Aim

Working Together on the Triple Aim

At the 2018 Quality Conference we unveiled our illustration on the Triple Aim at ELFT. Working on the Triple Aim is a key part of the Trust’s new strategy to improve the quality of life for all we serve.

The ideas for this illustration were inspired by staff, service users and carers at a half day workshop in February 2018. Illustrator Sonia Sparkles then took these ideas and created our patchwork version of the Triple Aim.

Find out more about the creation of this work in the video below. You can access a high quality version of the illustration here >>

Learn more about the Triple Aim here >>

Illustrating the Triple Aim at ELFT

Learn how ELFT staff, service users and carers came together to co-create our  illustration of the Triple Aim with Sonia Sparkles.

The final version of the illustration is available here>>

Working Together on the Triple Aim at ELFT

Please find our illustrated version of the IHI Triple Aim for ELFT. The ideas for this illustration were inspired by staff, service users and carers at a half day workshop in February 2018. Illustrator Sonia Sparkles then took these ideas and created our patchwork version of the Triple Aim.

Find out more about the creation of this work in this short video>>

High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs

There is solid evidence that leadership engagement and focus drives improvements in health care quality and reduces patient harm.1-10 Leaders at all levels in care delivery organizations are struggling with how to focus their leadership efforts and achieve Triple Aim results for the populations they serve. Triple Aim results represent the shift from volume to value, which demands that health care leadership at every level of care delivery organizations focus on improving the experience and outcomes of care provided and reducing the cost of care for the populations they serve.

High-impact leadership is required to achieve Triple Aim results. To that end, this white paper presents three interdependent dimensions of leadership: new mental models, High-Impact Leadership Behaviors, and the IHI High-Impact Leadership Framework.

Triple Aim: Improving the health of our local populations

During the IHI visit last week, Derek Feeley shared IHI’s learning from many years of work in systems across the world, helping improving health, improving the experience of care and lowering the cost of care.

There is a series of steps that has been found to be helpful in thinking about how to apply this framework.

1 – Choose a population to work with. This might seem simple, but often we start by thinking about services, rather than the population we want to serve. Choose a population that you can ‘get your arms around’, so one that is defined, and that you can actually count. And then get to know the needs of the population deeply.

2 – Articulate a Purpose that will hold all the stakeholders together. What would bring people together around a shared aim, and be aspirational?

3 – Develop a Systems approach. Develop the leadership and governance for the work. This can sometimes take a long time, so we might want to start with populations where this is already a stakeholder governance structure in place.

4 – Creating a Learning system, and choose Measures that will show improvement for the population. This is the stuff that we’re already familiar with from our QI work to date. The measures will need to cover all three aspects of the triple aim – health outcomes, care experience and cost.

5 – Develop a Portfolio (group) of projects that will help to deliver the triple aim results. No single project is likely to accomplish the triple aim by itself.

6 – Create a Team of people who can manage the work: executive sponsor, portfolio lead, project lead, improvement advisor etc… again, this is what we’ve already been doing for our QI work within ELFT

7 – Develop a plan for Execution – essentially this is the roadmap for the QI projects, using the Model for Improvement

Pursuing the Triple Aim

In this article John W. Whittington, Kevin Nolan, Ninon Lewis, and Trissa Torres describe and provide examples of each of these 3 core components, as well as case examples of 2 organizations (Bellin Health of Green Bay, Wisconsin, and Chinle Service Unit of the US Indian Health Service), to illustrate the execution of all 3 of the Triple Aim’s components.

A Guide to Measuring the Triple Aim

A useful system of measurement for the Triple Aim is essential to this work. Although no single organisation or region has yet achieved an ideal, comprehensive measurement system for the Triple Aim, good examples and data sources are now available to illustrate how measurement can fuel a learning system to enable simultaneous improvement of population health, experience of care, and per capita cost of health care.