Introducing the Model for Improvement in a Scottish Hospice

Background & AimThe Scottish Government’s 2020 Vision for healthcare in Scotland is to provide safe, high quality care, whatever the setting. National quality improvement programmes have been developed to deliver these ambitions, resulting in an increase in improvement activity across NHS Scotland (Healthcare Improvement Scotland, 2014).However, the spread of improvement methodologies through the Scottish hospice sector has been considerably less dramatic. Indeed, there appears to be relatively little uptake of improvement as a specific model for achieving quality and effectiveness, in spite of its adoption elsewhere.Working in partnership with the University of the West of Scotland, the aim of this project is to investigate and improve the hospice patient’s journey, particularly with regard to optimising timing of referral and referral-to-bed time.
MethodsUsing a variety of quality improvement tools, such as run charts, process mapping, cause and effect and force field analysis, areas for improvement were identified at Ardgowan Hospice. Plan, Do, Study, Act (PDSA) cycles are testing change ideas and assessing the impact on the referral pathway and patient experience.
Results Ardgowan hospice has improved the accuracy of current data collection and identified bottlenecks in the referral pathway. Staff engagement has generated change ideas to improve services and patient experience. Overall, the median waiting time for all hospice services from referral to service commencement was four days. Once data was adjusted to working days and the information collected was standardised using operational definitions, the overall median reduced to two days. Currently PDSA cycles are testing changes where care is being offered (clinic versus home) and the results are being assessed and ideas refined before change is implemented. 
ConclusionUsing the model for improvement as a framework to guide improvement at Ardgowan hospice has empowered staff to identify areas for improvement and generate change ideas.